Project End Date (PED) - Extension Request

Project End Date (PED) - Extension Request

Submit this Form if your PED has Expired or is set to expire within the next 6 months.

This form is only to be used to extend the Project End Date and is not intended to replace any other submittal process.

Name*

Name of Individual submitting form

Email*

Phone Number*

District*

Select or enter value

Local Public Agency*

Project Number xxxx(xxx)*

Local Assistance - Area Engineer

Name of District Area Engineer if known. Otherwise leave blank

Area Engineer Email

Area Engineer will be copied on request

Current Approved Project End Date

Is this an ER Project?*

Select or enter value

Are you requesting a PED Extension?*

Select or enter value

Reimbursable Work Status*

Indicate whether reimbursable work is currently being performed on the project.

Select or enter value

Justification for PED Extension*

Examples of situations which may justify a revision to the PED include, but are not limited to: litigation, major changes in design, environmental or permit issues, construction claims, differing site conditions, significant additional work, area-wide material shortages, labor strikes, unusually severe weather, or other events which are outside the control of the LPA.

Select or enter value

Expanded Justification for PED Extension*

Please limit Expanded Justification language to 2 or 3 sentences as appropriate.

Reason for Not Requesting PED Extension*

Select or enter value

Expanded Reason expired PED not being extended*

Estimated Phase Completion Date*

The Estimated Phase Completion Date is not the PED (see Note below).

Note: The PED is established by adding 12 months to the LPA's estimated date of completing the authorized phase of work (Date entered above).

Attach any other Supporting documents here

Optional (Only use if required).

Drag and drop files here or

Certification*

I certify the justification and proposed Completion Date proposed in this form are valid, and the extension request is necessary.

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Send me a copy of my responses

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